essential list for simulation-based learning (cataract surgery) · 2017-12-18 · 4 essential list...

2

ESSENTIAL LIST for Simulation-Based Learning (Cataract Surgery)

INTRODUCTION

IAPB considers appropriate information as a vital resource in improving universal access to eye health In resource-constrained settings especially procurement decisions can play an important role in ensuring that a maximum number of people have equitable access to quality services

An investment in appropriate equipment and other items can ensure optimal eye health enhancing the quality of life of the beneficiaries Further it can enhance sustainability of eye health services and provide a satisfactory social return Therefore IAPB collaborates on the development of a series of lsquoIAPB Essential Listsrsquo to assist NGOs Ministries of Health district health services eye clinics and hospitals in decision-making about the items best suited their setting These lists are a useful resource to assist in planning and purchasing inventory to support the delivery of quality care

What do these lists containIAPB consults publications and panels of experts in their fields from around the world many with considerable experience in resource-constrained settings to compile these lists The experts reach consensus on equipment instruments pharmaceuticals consumables and other resources considered essential to provide quality eye health interventions They also identify items that are desirable and recommend that efforts should be made to obtain these budget allowing

Why is this list importantSimulation is designed to replicate clinical scenarios in order to augment learning of diagnostic or surgical procedures through deliberate practice This list describes the items required for learning cataract surgery in a simulated environment Skills acquired within a simulated environment have been shown to transfer to improvements in procedures on actual patients Further the use of simulation in health professionalsrsquo education

bull has become ethically ldquoimperativerdquo due to patient safety concerns the need to reduce avoidable medical errors and to protect patients whenever possible

bull provides an alternative and equivalent experience to cadaveric and animal models which have ethical and moral issues surrounding their use

bull provides many and immediate training opportunities learners donrsquot have to wait for a particular ldquoreal-liferdquo case or pathology to present itself

3


What does this list containThis list contains recommendations for a range of equipment instruments consumables and pharmaceuticals learners can use to practice in a simulated environment to prepare them to do surgery Ideally the skills laboratory should include as many of the same instruments and equipment that the students are likely to use in future in order for them to become familiar with these

We recognise that some options included in the EL are expensive or may be unobtainable in certain areas but nevertheless these represent aspirational best practice

Where possible we have suggested alternatives to help training institutions to contain costs and ensure simulation training is as cost-effective as possible

Sections of the ELTo learn a new skill quantity of practice is necessary but optimal performance is dependent on the quality of the practice itself Practice makes perfect but practicing the wrong technique does not Thus in addition to ensuring that the items required in a digital dry and wet lab for optimal learning are available the envisaged learning outcomes should be included within structured cataract surgery curricula both for those initially learning cataract surgical procedures to those wishing to continue their professional development in this field This list is thus separated into the following sections

bull Dry Labs

bull Wet Labs

Surgical Skills Labs

bull Videos online tutorialsfeedback Virtual reality

Digital Labs

bull Learning and Assessment Material

Simulation Plus

4


1 Simulation plus ndash learning and assessment materialSimulation as part of a ldquoskills curriculumrdquo can accelerate learning especially if guided by the selection of appropriate competencies and ldquodeliberate practicerdquo activities that have been specifically designed to improve the current level of performance

bull Learning activities may include demonstration videos didactic instruction by peers andor more senior students written material lectures procedural demonstrations by experts ndash face to face or via teleconferencing

bull Structure learning activities and assessment using a standardized and objective tool such as the ICO-OSCAR

bull Document and reflect on learning for assessment and to contribute to certification requirements using paper or electronic logbooks and portfolios

bull Feedback formative and summative assessments can either be during andor after using videos This can be self-assessment or assessment from experienced peers and from experts face-to-face or using multipoint video-conferencingtelemedicine facilities Plans should be in place to enable the learner to do closely supervised procedures on actual patients once they have reached an adequate level of competence using the simulation

2 Digital labsDigital labs may include videostutorials for initial learning of procedures and feedback via the internet Virtual reality may be used to provide a more interactive environment

bull Virtual reality simulation

bull Demonstration videos tutorials manualsguides

bull Digital recording for feedback formative and summative assessment

3 Surgical skills labs

31 Dry labsDry labs may include bench models and box-trainers ndash simulators that are static and can be placed on the ldquobenchrdquo in front of the learner to practice instrument handling basic skills procedures or steps of procedures Using for example a stereo-optical microscope or bench top operating microscope to practice skills such as suturing practice on examination gloves suture packaging or orange peel

5


32 Wet labsWet labs may include bench top operating microscopes dedicated operating microscopes or the existing operating microscope in the operating theatre to practice surgical techniques complication management and common mistakes

How can quantities be calculatedThe instruments and consumables are calculated for one learner

DescriptionEssential (E) or Desirable (D)

Quantity Required

SIMULATION PLUS LEARNING AND ASSESSMENT MATERIALOn-line open sourced resources

The Iowa Ophthalmology Wet Laboratory httpwebeyeophthuiowaedueyeforumtutorialsIowa-OWLindexhtm Cataract Surgery for Greenhorns httpcataractsurgeryforgreenhornsblogspotcoza

E 1

Patient Communication during Cataract Surgery An Eye Rounds Tutorial ndash Brinton JP and Oetting TAhttpwebeyeophthuiowaedueyeforumtutorialsCommunication-Cataract-Surgeryhtm

E 1

Orbis CybersiteLecture on setting up a wet lab from some of the worldrsquos expertshttpscybersightorgportfoliotraining-of-ophthalmic-educators-orbis-coecsaldquoFundamentals in MSICS courserdquo as pre-learning for hands-on training httpscybersightorgonline-learning

E 1

The Virtual Cataract Surgery Course Manual for Ophthalmology Residents 2016 Edition Li E Paul A A Greenberg PB Warren Alpert Medical School of Brown University httpsrepositorylibrarybrownedustudioitembdr583598 DOI httpdxdoiorg107301Z08913SK

E 1

ICO OSCARs (International Council of Ophthalmologyrsquos Ophthalmology Surgical Competency Assessment Rubric or ICO-OSCAR)Small Incision Cataract Surgery (SICS) Extracapsular Cataract Extraction Phacoemulsification (English) Some available in Chinese French Portuguese Russian Spanish Vietnamesehttpwwwicophorgresources230Surgical-Assessment-Tool-ICO-OSCAR-in-English-and-Spanishhtml

E 1

DIGITAL LAB

Virtual reality simulationeg Eyesireg ophthalmosurgical simulator (VRMagic Mannheim Germany) httpswwwvrmagiccomsimulatorspublicationseg MicroVisTouch (ImmersiveTouch Chicago) eg Touch Surgery httpswwwtouchsurgerycomeg Cataract Master (phacoemulsification cataract surgery) Mass Eye and Ear American Society of Cataract and Refractive Surgery

D 1

6



Quantity Required

Demonstration videos tutorials manualsguideseg httpwebeyeophthuiowaedueyeforumvideoINDEXhtmeg httpsimulatedocularsurgerycomeg httpgallerysimulatedocularsurgerycomregisterhttpgallerysimulatedocularsurgerycomloginThe Royal College of Ophthalmologists Simulation Gallery a repository for high quality surgical training videos from around the world which will enable ophthalmologists to share their teaching tips for a particular procedure and for trainees to share their training experiences

E 1

Digital recording for feedback formative and summative assessment

Operating microscope with an external monitor and records simulation surgery ndash httpsiapbstandardlistorgproduct-categorywetdry-lab-operating-microscope

Set up phone or tablet to record through teaching scopes

E 1

Monitor Flat screenflat screenphonetablet E 1

Internet connectionbull to overcome space constraints and add scalability to the methodbull to use for teaching and assessment

D 1

SURGICAL SKILLS LAB WET amp DRY LABRoom1

Room spacious and easily accessible E 1

Sink and draining board for washing up instruments after use with other instrument cleaning equipment eg receivers etc

E 1

Small fridge D 1

Microwave D 1

Working bench or table at sitting level with stools for learners Length determined by the number of lsquostationsrsquo to be set up

E Per Station

Stools height-adjustable if possible E Per Station

Storage Locker(s) D Per Learner

Sockets for electrical equipment E Per Station

Surge protection E Per Station

SYSTEMSKITS FOR SKILLS LABSKitaro Kits httpwwwfci-ophthalmicscomblogkitaro-kits-a-superior-way-to-practice-cataract-surgeryDry Lab ndash to practice instrument handling and basic steps of cataract surgery such as capsulorhexis IOL insertion etc without the need of a microscope and phaco machine monitors eye movement upon instrument contact to mimic a real surgical environmentWet lab ndash Use artificial eyes to practice completeing surgical techniques complication management and common mistakes

D Per Station

Pharmabotics Limited wwwpharmaboticscom ndash designed in cooperation with RCODry Lab Skills Board for practicing basic skills techniques Wet Lab Skills Board use with artificial eyes andor with animalsrsquo eyes

D Per Station

1 httpwebeyeophthuiowaedueyeforumtutorialsIowa-OWLvideowetlab-setuphtm ORBIS Wet Lab Course Outline ndash MSICS

7



Quantity Required

Practice eyes ndash to use in a dry or wet lab

For practising steps use lower fidelity models eg for capsulorhexis use grapestomatoes ANDOR

Use animal eyes for practising surgery

E As required to learn

Syntheticartificial practice eyes ndash Various models eg Kitaro httpswwwgooglecomsearchq=kitaro+artificial+eyesampie=utf-8ampoe=utf-8ampclient=firefox-bampgfe_rd=crampdcr=0ampei=Iq7TWbPoDMz38AeJ0IbABAeg Phillips Studio artificial eyes httpwwwphillipsstudiocoukwppagessicshtml

D As required to learn

FoamMount ndash httpophthalmicwetlabtoolboxblogspotpeE 1 Per

Station

Manikin Head ndash httpphillipsstudiocoukD 1 Per

Station

EQUIPMENTBench Top microscope ndash httpsiapbstandardlistorgproduct-categorywetdry-lab-operating-microscope

Optical microscope eg bull model D stereo microscope httpwwwmicroscope-depotcomseriesDasp2

E 1 Per Station

Simpler operating microscope (OM) egbull SCANOPTICS Skills lab model SO-1700W ndash

httpsiapbstandardlistorgthe-productswet-lab-microscope-so-1700w bull ZEISS Stemi 305 EDU cam

D 1 Per Station

Portable Operating Microscope This provides higher fidelity than a bench top model eg foot controls ndash httpsiapbstandardlistorgproduct-categoryportable

Low cost surgical microscopes eg bull INAMI ndash L0940SD ndash

httpsiapbstandardlistorgthe-productsportable-operating-microscope bull KAPS ndash SOM82 ndash httpsiapbstandardlistorgthe-productskaps-som-82-

table-mounted-ophthalmic-microscopeCan also use existing OM in theatre

E 1 Per Station

A lower cost but sophisticated surgical microscope eg bull MAPPASAMY ndash AAOM250P LED ndash

httpsiapbstandardlistorgthe-productsoperating-microscopebull SCANOPTICS ndash SO111TZSO 5000 RFZ ndash

httpsiapbstandardlistorgthe-productsportable-microscope-so-111tzamp httpsiapbstandardlistorgthe-productsportable-microscope-so-5000tfz

bull LEICA ndash M220 ndash httpsiapbstandardlistorgthe-productsoperating-microscope-m220-without-xy

D 1 Per Station

Observers Tube for OM (available for most brands of Microscopes ndash check with manufacturer)

E 1 Per Station

OM Spare Bulb and Fuse Pack (for halogen bulbs ndash not LED) E 1 Per Station

Floor Stand for OM E 1 Per Station

2 Does not have the foot petal or full range of an ophthalmic skills lab microscope but costs less than $300USD and when paired with a magnifying ndash8D lens allows for longer focal distance and ability to practice many steps in cataract surgery httpophthalmicwetlabtoolboxblogspotpe

8



Quantity Required

Portable Operating Lamp with stand ndash httpsiapbstandardlistorgproduct-categoryoperating-lights

E 1 Per Station

Spare Bulbs for lamp (for halogen bulbs ndash not LED) E 1 Per Station

Instrument trolley E 1 Per Station

Kidney Bowl 05L E 1 Per Station

Gallipots E 1 Per Station

Stand for fluids E 1 Per Station

Focus on MSICSE

Phaco-machine ndash httpsiapbstandardlistorgproduct-categoryphacoemulsification-equipment

D

INSTRUMENTS3

httpsiapbstandardlistorgproduct-categoryinstruments-eye-surgery

Basic instrument sets

Instruments recycled from OT

E 1 Per Station

Full range of surgical instruments similar to those used in their operating theatre41 Per Station

ForcepsForceps for wet field electric cautery (Unipolar amp Bipolar) E 1

Forceps Superior rectus Landolt style E 1

Forceps Conjuctival 03mm Toothed Moorfields E 1

Forceps Conjuctival Non-Toothed Moorfields E 1

Forceps Mosquito curved (SL ldquoHartmann Mosquito Forceps 325rdquo Curvedrdquo) E 1

Forceps Mosquito straight (SL ldquoHartmann Mosquito Forceps 325rdquo Straightrdquo) E 1

Forceps Corneal 012mm Atraumatic Tips Angled with Tying Platform E 1

Forceps Corneal 1x2 Teeth 012mm with 6mm Tying Platform E 1

Forceps suture tying cilia or Birks E 1

Forceps Lens Introducing Angle to Tip 8-12mm Smooth Jaw Kellman Mc Pherson E 1

Forceps Capsulorhexis Angle to Tip 11mm Sharp Tip to use as a Cystotome Utrata E 1

Needle holdersNeedleholder none locking Straight for 40 50 60 or 70 Suture E 1

Needleholder none locking Curved or Straight overall length 10-11mm Jaws 8mm for 80 to 100 Suture

E 2

3 Also see httpwebeyeophthuiowaedueyeforumtutorialsinstrumentsPhacoindexhtm4 Using similar instruments to those used in the operating theatre where students will be operating provides familiarity

and continuity for students

9



Quantity Required

Blades and handlesTroutman blade handle non fixed handle Bard Parker for Single Use Knives or Purchase disposable Knives amp Handle combinedfixed

E 3

BP 15 or 11 or 15 degree or 11mm paracentesis MVR tip E 3

Blade SlitKeratome 25-32mm angled bevel up E 3

Knife Crescent Angled Bevel Up 25-30mm E 3

ScissorsScissors Conjunctival Westcotts E 1

Scissors Corneal Section (Corneoscleral) 10mm blades D 1

Scissors Angled 10mm Extra thin Blades Barraquers E 1

Scissors iridectomy 10mm blades De-Weckerrsquos OR Vannas E 1

Scissors Capsulotomy fine D 1

Scissors iris sharp pointed E 2

Ordinary Scissors (for cutting big sutures and threads and eye lashes) E 2

CannulaCannula Rycroft 30 gauge E 2

Cannula Air Injection 27G Angle to Tip 5mm E 2

Cannula Visco-Elastic 22G Angle to Tip 10mm D 2

Cannula Simcoe IrrigatingAspirating 23G Angled aspiration through top opening 15mm

E 4

Cannula Irrigating Vectis Three Ports 23G E 2

OtherVertical chopper useful for any type of cataract D 1

Pre chopper ndash enables to fracture the nucleus in the bag without the need of phaco ndash possibly to extract half of the nucleus at a time eg Ernst micro nucleus cracker or Micro Akahoshi

D 1

Kuglen Iris Hook and Lens Manipulator (with Clover Leaf Tip Angled) D 1

Sinskey hook straight or angled E 2

Lens Espressor (Hook) D 1

Iris Spatula or repositor Nettleship D 1

Vectis Lens Loop or wire Snellen Lens Loop E 1

Muscle Hook or squint hook Graefe E 1

Cautery Ball or electric cautery E 1

Calipers 1-20mm in 1mm Increments E 1

Speculum 12mm Blade (Adult and child) E 1

Speculum adjustable Barraquerrsquos Weiss or wire speculum Cook or Liberman E 1

SICS ndash ADDITIONAL INSTRUMENTS Troutman blade handle non fixed handle Bard Parker for Single Use Knives or Purchase disposable Knives amp Handle combinedfixed

Keratome (bevel up) 27-35mm

Knife SlitKeratome Angled 32mm (bevel up)

Knife Crescent Angled 25mm (bevel up)

10



Quantity Required

Knife MVR 19G

Knife 15 Degree Stab

PHACO ndash ADDITIONAL INSTRUMENTS Phacoemulsification Machine httpsiapbstandardlistorgproduct-categoryphacoemulsification-equipment

E 1

Phaco Hand Piece tip and accessory pack with silicone sleeve E 1

Irrigation ndash Aspiration tip (co-axial) E 1

Bimanual irrigation hand pieces E 1

Spatulated irrigation cannulas for hydrodissection D 2

Troutman blade handle non fixed handle Bard Parker for Single Use Knives or Purchase disposable Knives amp Handle combinedfixed


Knife MVR 19G

Phaco chopper vertical and horizontal E 1

Spatula fine iris E 1

Forceps IOL folding and inserting E 1

Cystomes can be build with a needle and mosquito if required D 2

Blades (included in sets)

SURGICAL CONSUMABLES AND SUPPLIES

Use leftover andor expired consumables from the OT eg bull Use leftover sutures bull Use expired IOLs Use substitutes eg bull KY Jelly or other clear lubricant in place of Viscoelastic bull Blue food dye in place of Trypan blue

E

Full range of surgical consumables and supplies similar to what is used in their OT5

D

Needles ndash httpsiapbstandardlistorgproduct-categorysyringes-needles

Needle 30G E 50

Needle 25G E 50

Needle 23G 30-35mm long D

Needle 26G D

Needle 27G D

Needles superior rectus for 40 cutting silk E 5

Syringes5ml disposable syringes leur lock E 5

2ml disposable syringes leur lock E 5

1ml disposable syringes leur slip E 5

Sutures ndash httpsiapbstandardlistorgproduct-categorysutures

5 Using similar surgical consumables and supplies to those used in the operating theatre where students will be operating provides familiarity and continuity for students

11



Quantity Required

90 Nylon double armed sutures spatulated needles D

100 Nylon double armed sutures spatulated needles E 10

40 Black Braided Silk on a Reel E 1

Prolene 50 double armed with spatulated needles D

10-0 9-0 and 8-0 nylon D

6-vicryl D

IOLS ndash httpsiapbstandardlistorgproduct-categoryiols

IOLs Single Piece (PMMA) with Dialling Holes E 10

1 piece acrylic 3-piece acrylic D 5

AC Lenses Three or Four Point Fixation E 5

Capsular tension ring (11mm) D 5

OtherGloves (different sizes 65 ndash 85) ndash httpsiapbstandardlistorgproduct-categorygloves

E 10 each size

Antiseptic hand scrub minimum 70 alcohol (500ml)handwash solution (500ml) E 1

Perasafe sterilizing powder 81g E 1

Isopropyl alcohol 70 minimum E 1

Sodium hypochlorite E 1

Chlorhexidine aqueous 05 E 1

Trypan blue 006 1ml ndash httpsiapbstandardlistorgthe-productstrypan-blue-1ml-inj E 5 vials

Ringers Lactate 500ml ndash httpsiapbstandardlistorgthe-productsringers-lactate-1000ml

E 5

Viscoelastic (75cc) E 10

12


ACKNOWLEDGEMENTS

IAPB wishes to acknowledge and thank the following experts and organisations for their input and support in compiling this list including the International Council of Ophthalmology (ICO) and The Iowa Ophthalmology Wet Laboratory

bull Amelia Geary ORBIS Director Program Development amp Quality

bull Dr William Dean Honorary Senior Lecturer Division of Ophthalmology University of Cape Town Clinical Research Fellow LSHTM

bull Dr Helena Filipe International Council of Ophthalmology (ICO) Committee for Continuing Professional Development (CPD) Chair Hospital of the Armed ForcesPL-EMGFA Consultant of Opthalmology College of Opthalmology of the Portuguese Medical Association Board Member

bull Dr Regraveneacutee du Toit Independent Eye Health Consultant

bull Philip Hoare Procurement amp Standard List Manager IAPB

bull Gerhard Schlenther RANZCO

bull Dr Neil Murray RANZCO and Fred Hollows Foundation NZ

bull Dr John Ferris Consultant Ophthalmolgist

Published by International Agency for the Prevention of Blindness London School of Hygiene and Tropical Medicine Keppel Street London WC1E 7HT England UK

Tel +44 (0)20 7927 2973 Fax +44 (0)20 7958 8325 Email communicationsiapborg Registered Charity No 1100559 Company Limited by Guarantee Number 4620869

Registered in England and Wales

wwwiapborghttpiapbstandardlistorg

WORKING TOGETHER TO ELIMINATE

AVOIDABLE BLINDNESS

IAPBrsquos ESSENTIAL LISTS identify equipment and consumables considered essential minimum requirements

to perform high quality eye health interventions IAPB produces these lists in collaboration with leading

experts from around the world and updates them from time to time

3


What does this list containThis list contains recommendations for a range of equipment instruments consumables and pharmaceuticals learners can use to practice in a simulated environment to prepare them to do surgery Ideally the skills laboratory should include as many of the same instruments and equipment that the students are likely to use in future in order for them to become familiar with these

We recognise that some options included in the EL are expensive or may be unobtainable in certain areas but nevertheless these represent aspirational best practice

Where possible we have suggested alternatives to help training institutions to contain costs and ensure simulation training is as cost-effective as possible

Sections of the ELTo learn a new skill quantity of practice is necessary but optimal performance is dependent on the quality of the practice itself Practice makes perfect but practicing the wrong technique does not Thus in addition to ensuring that the items required in a digital dry and wet lab for optimal learning are available the envisaged learning outcomes should be included within structured cataract surgery curricula both for those initially learning cataract surgical procedures to those wishing to continue their professional development in this field This list is thus separated into the following sections

bull Dry Labs

bull Wet Labs

Surgical Skills Labs

bull Videos online tutorialsfeedback Virtual reality

Digital Labs

bull Learning and Assessment Material

Simulation Plus

4













5





Quantity Required



E 1


E 1


E 1


E 1


E 1

DIGITAL LAB


D 1

6



Quantity Required


E 1




E 1



D 1




E 1

Small fridge D 1

Microwave D 1


E Per Station






D Per Station


D Per Station


7



Quantity Required








Station


Station



E 1 Per Station



D 1 Per Station





E 1 Per Station





D 1 Per Station


E 1 Per Station




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




4













5





Quantity Required



E 1


E 1


E 1


E 1


E 1

DIGITAL LAB


D 1

6



Quantity Required


E 1




E 1



D 1




E 1

Small fridge D 1

Microwave D 1


E Per Station






D Per Station


D Per Station


7



Quantity Required








Station


Station



E 1 Per Station



D 1 Per Station





E 1 Per Station





D 1 Per Station


E 1 Per Station




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




5





Quantity Required



E 1


E 1


E 1


E 1


E 1

DIGITAL LAB


D 1

6



Quantity Required


E 1




E 1



D 1




E 1

Small fridge D 1

Microwave D 1


E Per Station






D Per Station


D Per Station


7



Quantity Required








Station


Station



E 1 Per Station



D 1 Per Station





E 1 Per Station





D 1 Per Station


E 1 Per Station




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




6



Quantity Required


E 1




E 1



D 1




E 1

Small fridge D 1

Microwave D 1


E Per Station






D Per Station


D Per Station


7



Quantity Required








Station


Station



E 1 Per Station



D 1 Per Station





E 1 Per Station





D 1 Per Station


E 1 Per Station




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




7



Quantity Required








Station


Station



E 1 Per Station



D 1 Per Station





E 1 Per Station





D 1 Per Station


E 1 Per Station




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




8



Quantity Required


E 1 Per Station






Focus on MSICSE


D

INSTRUMENTS3




E 1 Per Station















E 2



9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




9



Quantity Required


E 3















E 4




D 1















10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




10



Quantity Required

Knife MVR 19G



E 1







Knife MVR 19G








E


D


Needle 30G E 50

Needle 25G E 50


Needle 26G D

Needle 27G D







11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




11



Quantity Required





10-0 9-0 and 8-0 nylon D

6-vicryl D







E 10 each size








E 5


12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS




12


ACKNOWLEDGEMENTS















AVOIDABLE BLINDNESS









AVOIDABLE BLINDNESS




essential list for simulation-based learning (cataract surgery) · 2017-12-18 · 4 essential list...

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